AccountId: 011433970860
ContactId: 4c81f500-5125-46c6-af8e-0920d1c5e813
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 466109 ms
Total Talk Time (AGENT): 198667 ms
Total Talk Time (CUSTOMER): 233381 ms
Interruptions: 5
Overall Sentiment: AGENT=1, CUSTOMER=0.5
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/04/18/4c81f500-5125-46c6-af8e-0920d1c5e813_20250418T22:37_UTC.wav
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[CUSTOMER][NEUTRAL] you
[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Yeah, good afternoon, [PII].
[CUSTOMER][NEUTRAL] Uh, my, my name is [PII]. I am a provider.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] And I need the information. I, I, I just talked a couple of minutes ago with a person named [PII].
[CUSTOMER][NEUTRAL] And um we got a claim that was denied supposedly you pay the claim to the, the patient.
[AGENT][NEUTRAL] Uh-huh.
[CUSTOMER][NEUTRAL] And I called the patient. He says he never get any received any check for you regarding this bill. So I was wondering if you could, uh, clarify what is going on.
[AGENT][POSITIVE] Oh yeah, oh my goodness, that sounds like a mess. Yeah, we could definitely see what's going on. Um, hello, can I get a good call back number from you first in case we're disconnected please?
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Thank you. And then do you have that policy number?
[CUSTOMER][NEUTRAL] Yes, it
[CUSTOMER][NEUTRAL] 024.
[CUSTOMER][NEUTRAL] 969.
[CUSTOMER][NEUTRAL] 29.
[AGENT][NEUTRAL] OK and then uh what was the name and date of birth for the member please?
[CUSTOMER][NEUTRAL] Patient's name is [PII] who is.
[CUSTOMER][NEUTRAL] And date of birth is [PII].
[AGENT][POSITIVE] Perfect, thank you for verifying that. uh, do you have that claim number by chance?
[CUSTOMER][NEUTRAL] Yes, claim number.
[CUSTOMER][NEUTRAL] 353589042
[AGENT][POSITIVE] OK, thank you one moment please.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Oh, OK, so this one was a duplicate, uh.
[AGENT][NEUTRAL] Claim, I believe. Let me see.
[CUSTOMER][NEUTRAL] Yeah, because I, yeah, I want to send here to me.
[AGENT][NEUTRAL] Sure, yes, OK.
[CUSTOMER][NEUTRAL] Uh, the cold, the, yeah, mhm.
[AGENT][NEUTRAL] Sure, OK, yeah, so I am showing record that we did send this payment to the um insured so if the member has not received this payment they would need to call us so we can see what was going on with that.
[AGENT][NEUTRAL] The way that it works is that they were the ones to file the claims we would send the payment to them if the provider files the claim we send the payment to the provider.
[CUSTOMER][NEUTRAL] Yeah, because I
[CUSTOMER][NEUTRAL] Yeah, that's why I talked to him, he said.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEGATIVE] He never sent you the claim, that's the first. And he says, you, you never received any check from you. The only check if he received it from from you was.
[CUSTOMER][NEUTRAL] The emergency room, he rented $300 and no more, that's what he said.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Well we're gonna have to speak with him regarding that because that is the record that we have is that he did file this claim and we did send that payment to him so if there's any confusion with that he would need to give us a call.
[CUSTOMER][NEUTRAL] So now I have this dilemma and see.
[CUSTOMER][NEUTRAL] I, I asked him to do so, cause he, he, uh, he says, no way, I never did that.
[AGENT][NEUTRAL] OK, he needs to, he needs to give us a call then if that's the case.
[CUSTOMER][NEUTRAL] Cause he, he looks like a serious man, so.
[CUSTOMER][NEGATIVE] Yeah, and that is another way to escalate this this thing because I don't want to.
[AGENT][NEUTRAL] No, as as he is the one who did that though, um, where I'm not able to give that check information, um, so he would have to be the one to call us so we can get that straightened out.
[CUSTOMER][NEUTRAL] I don't know, I, I don't want to get up too much.
[CUSTOMER][NEUTRAL] OK. So he says he will. So I just call you to uh get a
[CUSTOMER][NEUTRAL] We up to date so he says no, no, I never, I never, he says I never received it. I'm gonna call you. That's what he said. So I just call in anticipation to see, to be sure, to be sure that the the first information I got from the person from your department was.
[AGENT][NEUTRAL] He said what? I'm sorry?
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Sure.
[AGENT][NEUTRAL] Yes.
[CUSTOMER][POSITIVE] Correct.
[AGENT][POSITIVE] Yes, that is correct.
[CUSTOMER][NEUTRAL] Well, let's wait. Uh, let's see until Monday. If you're not, you're gonna see what you're gonna do.
[CUSTOMER][NEUTRAL] Uh, uh, I, I have, I have, yeah, I have another question here.
[AGENT][NEUTRAL] Uh, I'm sorry.
[AGENT][NEUTRAL] Uh-huh.
[CUSTOMER][NEUTRAL] The claim we looking here is from 10-11-2024 through.
[CUSTOMER][NEUTRAL] [PII]. However, I sent to you more claims with different dates. I was wondering.
[CUSTOMER][NEUTRAL] If he filed the claim for different date too.
[CUSTOMER][NEUTRAL] For example,
[AGENT][NEUTRAL] Um, if he did, um, let, let me see just a moment, OK, you mean the claim that you sent in that was that uh 042, you mean, is that right?
[CUSTOMER][NEUTRAL] Yeah, yeah, I have the dates for for
[AGENT][NEUTRAL] On that claim?
[CUSTOMER][NEUTRAL] Uh, [PII] to
[CUSTOMER][NEUTRAL] [PII], that's that's the letter I received from you.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] For the explanation of benefits.
[AGENT][NEUTRAL] Let me see.
[AGENT][NEUTRAL] So under this one that uh you sent in the one ending in 042 um I do see one for.
[AGENT][NEUTRAL] Of course, most of them are stating that they were duplicates, however,
[AGENT][NEUTRAL] I saw one. Give me just a moment.
[CUSTOMER][NEUTRAL] Cause I have another date I sent to you, yeah.
[AGENT][NEUTRAL] So, there's one.
[AGENT][NEGATIVE] That was for [PII] um that does state that physical therapy is not covered under this policy so we're we're simply unable to pay that benefit as for that's the only thing everything else that was submitted uh was a duplicate.
[AGENT][NEUTRAL] And was paid to the insured.
[AGENT][NEUTRAL] And if you need record of this holo, I can send you an EOB uh that has all of this information if you haven't received that already that does state that the um insured received this payment.
[CUSTOMER][NEUTRAL] Yeah, because it will be I have here is for [PII]. Yeah, to [PII]. Uh, do you have a, uh, [PII] with you?
[AGENT][NEUTRAL] You do.
[AGENT][NEUTRAL] Do I have what? I'm sorry?
[CUSTOMER][NEUTRAL] The date
[CUSTOMER][NEUTRAL] The date of uh [PII].
[CUSTOMER][NEUTRAL] Do you have any claim with you there?
[AGENT][NEUTRAL] Not on this claim, not on this claim, um, this claim only has [PII]. 0, you mean just in general?
[CUSTOMER][NEUTRAL] No, not, not, not in this claim, not a claim, yeah.
[AGENT][NEUTRAL] Um,
[AGENT][NEUTRAL] Let's see that was [PII] you said?
[CUSTOMER][NEUTRAL] No, yeah, [PII].
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] Um, I don't have anything from.
[AGENT][NEUTRAL] [PII].
[AGENT][NEUTRAL] Let's see.
[CUSTOMER][NEUTRAL] Oh, OK, alright, this one I'm gonna take a look. Probably I didn't submit to you. I guess I had submitted.
[AGENT][POSITIVE] Sure, yeah, there's no timely filing limit so if there was anything missed, yeah, you can absolutely send that whenever.
[CUSTOMER][NEUTRAL] If I do it.
[CUSTOMER][NEUTRAL] Uh
[CUSTOMER][POSITIVE] OK, I'm gonna do it. Thank you very much.
[AGENT][POSITIVE] You are very welcome. Is there anything else I can help you with?
[CUSTOMER][NEUTRAL] No, let's wait until Monday. Let's see what he, he, he, he, he gonna send me.
[CUSTOMER][POSITIVE] And I go from there. Thank you.
[AGENT][NEUTRAL] What was that? I'm sorry?
[AGENT][POSITIVE] Oh yes, yeah, have him get with us so we can get that straightened out.
[CUSTOMER][NEUTRAL] Yeah, I wait, I am gonna wait until until Monday because he's, yeah, uh he says that uh he's gonna call you.
[AGENT][NEUTRAL] Of course.
[AGENT][POSITIVE] Absolutely, yeah, of course have a great rest of your day.
[CUSTOMER][POSITIVE] OK, thank you.
[CUSTOMER][POSITIVE] Thanks.
[CUSTOMER][POSITIVE] Thank you. The same, bye.
[AGENT][POSITIVE] Thank you. Bye-bye.